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Please complete the following form to register for Educational Classes provided through the Conemaugh Learning Institute, Department of Continuing Education.

Please note that this is not a secure website. All information you submit is given voluntarily and will only be used for services through Conemaugh Health System. Your information will never be shared or sold by Conemaugh Health System. 

First Name:
Last Name:
Discipline:
Street Address:
Address 2:
City:
State:
Zip Code:
   
Employer:
Department (CHS Employees):  
   
Primary Phone Number:
Fax Number:
Email Address:
   
Course Date:
Payment Total:


Print this form and include with your check or money order payable to "Conemaugh Memorial Medical Center".

Mail check or money order to:
Conemaugh Memorial Medical Center
Department of Continuing Education
1086 Franklin Street
Johnstown, PA 15905

To make a credit card payment:
Department of Continuing Education
(814) 534-9782